Healthcare Provider Details

I. General information

NPI: 1407220080
Provider Name (Legal Business Name): S.T.A.R. HOME HEALTH, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/19/2015
Last Update Date: 11/19/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2138 WOODSON RD SUITE #1
SAINT LOUIS MO
63114-5671
US

IV. Provider business mailing address

29 N MARGUERITE AVE
SAINT LOUIS MO
63135-2339
US

V. Phone/Fax

Practice location:
  • Phone: 314-801-8650
  • Fax: 314-801-8651
Mailing address:
  • Phone: 314-801-8650
  • Fax: 314-801-8651

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License NumberLC001467109
License Number StateMO

VIII. Authorized Official

Name: MRS. CHRISTINA MARIE CRIDDLE
Title or Position: MEMBER
Credential: RN
Phone: 314-518-5956